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CVD risk tied to estrogen loss in primary ovarian insufficiency
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In women with primary ovarian insufficiency, the risk for cardiovascular disease decreased with prolonged exposure to estrogen and increased with estrogen deprivation, according to findings published in Fertility & Sterility.
Jacob P. Christ, BS, of the department of reproductive medicine and gynecology at University Medical Center Utrecht in the Netherlands, and colleagues evaluated data from 385 women (mean age, 35 years; 88% white) with primary ovarian insufficiency from the University Medical Center Utrecht, Erasmus Medical Center and VU Medical Center between 1996 and 2016 to determine the association between estrogen exposure and deficiency and CVD risk. Primary ovarian insufficiency was defined as amenorrhea and follicle-stimulating hormone levels at least 40 IU/L before age 40 years. Mean lifetime estrogen exposure was 19.3 years, and mean estrogen-free period was 3.1 years.
Among participants, the calculated 30-year risks were 11.5% for general CVD events and 5.8% for hard CVD events; optimal general risk was 6.3% and optimal hard risk was 2.7%. Older age at screening was associated with prolonged estrogen-free period (P < .001) and lifetime estrogen exposure (P < .001) in univariate analyses. In multivariable regression analyses after adjusting for age, duration of estrogen deprivation was associated with LDL cholesterol (P = .034), non-HDL cholesterol (P = .028), hard risk for CVD (P = .001) and general risk for CVD (P = .004), and prolonged lifetime estrogen exposure was associated with lower LDL cholesterol (P = .024), non-HDL cholesterol (P = .027), hard risk for CVD (P = .005) and general risk for CVD (P < .001). Markers of CVD risk were not significantly associated with estradiol levels.
The hard risk for CVD was independently associated with the estrogen-free interval (P = .001) and lifetime estrogen exposure (P = .003). Further, general risk for CVD was independently associated with the estrogen-free interval (P = .008) and lifetime estrogen exposure (P = .02). The risk for hard or general CVD increased by 0.18% to 0.2% with each year a participant was without estrogen exposure independent of age, ethnicity, smoking status and BMI. The risk for hard or general CVD decreased by 0.15% to 0.16% with each year a participant was exposed to estrogen.
“The present study provides evidence the [estrogen] exposure and deficiency are independent contributors to risk of CVD among women with [primary ovarian insufficiency],” the researchers wrote. “These results emphasize the need for early recognition of [primary ovarian insufficiency] among practitioners, to prevent a delay in diagnosis and treatment. Furthermore, these results support the early and continued hormone replacement therapy among women with this disease, to prevent increased risk of CVD.” – by Amber Cox
Disclosures: Christ reports he received grants from the Fulbright US Student Program. Please see the study for all other authors’ relevant financial disclosures.
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